The Moral Property of Women

June 22, 2000

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Since 1988, when it became available in France, American women have been waiting for mifepristone. Also known as RU-486 (“the French abortion pill”), it was supposed to be the medical end run around the anti-choice movement–“the little white bombshell,” as the New York Times Magazine called it last year. Because it operates on very early pregnancies (forty-nine days or fewer), mifepristone escapes some of the opprobrium surrounding surgical abortion–there are no “babies,” no “precious feet,” no “partial births,” whatever they are. What the woman feels is cramps, what she sees looks like a period. Because it is just a pill, any family practitioner, any Ob-Gyn–or even, in states that permit it, any nurse practitioner or physician’s assistant–could prescribe it; the abortion itself is brought on by a second medication, misoprostol (already on the market as Cytotec, an ulcer treatment), and can even take place at home with the woman administering the required dose herself. Anti-choicers, the theory was, could hardly terrorize the thousands of doctors–40 percent of Ob-Gyns and 31 percent of family doctors in a just-released Kaiser Family Foundation survey–who told pollsters they would be “very” or “somewhat” willing to give the drug to their patients. Any minute, abortion would finally become what Roe v. Wade said it should be: a private medical matter between a woman and her doctor.

But with abortion nothing is inevitable, except that women will continue to have them. And so, despite the fact that in 1996 the Food and Drug Administration issued an “approvable letter” declaring mifepristone safe and effective, in early June the Population Council, which holds the US rights, and Danco, which is licensed to manufacture it, revealed that the FDA was considering major restrictions on its distribution and use. Basically, only doctors trained in performing abortions, with admitting privileges in a hospital no more than an hour away, would be allowed to prescribe the drug. In effect, mifepristone would be limited to the same besieged and dwindling band of doctors already doing abortions. The drug’s promise in fighting cancer, Cushing’s syndrome, endometriosis and fibroids would fall by the wayside.

This is politics, not science. Mifepristone has been around for twenty years and is legal in Austria, Belgium, China, Denmark, Finland, France, Germany, Greece, Israel, the Netherlands, Russia, Spain, Sweden, Switzerland and the United Kingdom. At this point it is one of the most tested and studied drugs in the world. More than half a million European women, and millions more in Asia, have taken it with excellent results. Thousands of American women have participated in trials; more than 90 percent say they would use it again. Yet despite this stellar track record–and unlike almost all FDA-approved drugs, which any physician can prescribe according to his or her own judgment–mifepristone would be classed with a handful of dangerous drugs such as thalidomide and Accutane, which cause serious birth defects and can be prescribed only under stringent conditions. Contrast the FDA’s footdragging on mifepristone with its lightning-swift approval of Viagra, stayed not a day by warnings that the impotence drug causes heart attacks.

The rationale for the proposed restrictions seems to be the small number of women (5 percent) for whom the drug results in an incomplete miscarriage. In their usual fearmongering, obscurantist way, anti-choicers have used this statistic to suggest that mifepristone is dangerous to women. But women miscarry all the time: Ob-Gyns and hospital emergency rooms are well equipped to give them the D and Cs they need. Family practitioners would of course have backup arrangements, the way they do for other emergencies. There is no need for them–or for the many Ob-Gyns who decline to perform surgical abortions but are willing to prescribe drugs–to be able to perform abortions themselves, any more than your dermatologist has to be able to perform cosmetic surgery. The FDA might as well require that only cardiologists prescribe Viagra.

In 1988, when the German firm that held the patent, Hoechst AG, refused to produce RU-486, the French government forced its French subsidiary to do so, declaring the drug, in the words of its creator, Etienne Beaulieu, “the moral property of women.” In the early nineties, the Feminist Majority gathered more than 700,000 petitions from US women, and statements from dozens of doctors and scientists, including a dozen Nobelists, to force the European manufacturers to make it available in America. After the intense hostility of the Bush Administration, which banned the importation of the drug for personal use–remember Leona Benten, who made headlines when she brought back the pill from England for her own use?–everything seemed finally on track. And yet here we are, seven years after President Clinton declared his support for the drug, and four years after the FDA issued its “approvable letter”–with nothing. Arguably, pro-choicers should have been making a huge fuss all along, instead of following the Population Council’s low-key, bureaucratic lead.

In any case, a huge fuss is what’s required now. Before September 30, when the FDA will issue its decision on mifepristone, pro-choice women and men, and members of the scientific and medical communities, must make themselves heard–to the FDA, to Congress, to President Clinton and the ever-reticent Vice President Gore. Start by insisting that your representatives oppose the Coburn Amendment, which would bar the FDA from approving mifepristone and which may come up for a vote in the House as early as the last week in June. But beyond that, the beleaguered but also sluggish pro-choice majority needs to take a leaf both from in-your-face groups like ACT UP and from moderate mass organizations like the Million Moms. Why not a demo on the steps of the FDA? Mothers for Mifepristone? A truth squad following Gore–and Bush, who says he’ll never let the drug come to market–around the campaign trail?